2025 – PAGE 179 – 180 – NEONATOLOGY

UMBILICAL CORD

Keep the umbilical cord/baby below mom’s waist for 30 seconds at birth, but DO NOT MILK IT. The cord should fall off by TWO weeks. If it has not fallen off by 4 weeks, consider LEUKOCYTE ADHESION DEFECT or other problems in which there is LEUKOPENIA (low WBCs).

CORD CATHETERS

Cord catheters should be placed at L3–L5 or T6–T10. Complications include hepatic infection (omphalitis), decreased femoral pulse, emboli to the liver, hemorrhage, and perforation of a bigger artery, but this does NOT CAUSE NEC.

MNEMONIC: “3 & 5 x2 = 6 & 10.” Remembering one set of numbers will help you remember the other. For example, if you remember L3–L5, simply multiply the digits by 2 to get T6–T10

SINGLE UMBILICAL ARTERY

The presence of a single umbilical artery is associated with renal anomalies, so obtain a RENAL ultrasound if this is mentioned. Also look for evidence of VATER/VACTER-L syndrome since up to 35% of patients with VATER/VACTER-L syndrome can have a single umbilical artery at birth.

• (TRIPLE TAKE) VACTER-L (AKA VACTERL or VATER) ASSOCIATION: VACTER-L (AKA VACTERL or VATER) syndrome is an acronym. VACTERL stands for Vertebral anomalies, Anal atresia/imperforate anus, Cardiac defects (especially VSD), Tracheoesophageal fistula, Radial hypoplasia, Renal anomalies, and Limb abnormalities. These children have a normal IQ.
• PEARL: The patient may present with a single umbilical artery.
• MNEMONIC: Imagine Darth VACTER cutting off his own son’s ARM (radial hypoplasia and limb abnormalities) and then using the ARM as a light saber to create ANAL ATRESIA and a TE Fistula.
• IMAGE: www.pbrlinks.com/VACTERL1
• IMAGE: www.pbrlinks.com/VACTERL2

HYPOSPADIAS

Hypospadias is associated with Opitz syndrome, Russell-Silver syndrome and sometimes with Beckwith-Wiedemann syndrome. It can be associated with renal anomalies, but as a general rule, the more distal the lesion, the less chance of renal problems.

• PEARL: Opitz syndrome is characterized by midline birth defects, such as agenesis of the corpus callosum, hypertelorism, cleft lip, heart defects, and hypospadias.
• NAME ALERT: Do not confuse Opitz syndrome with Smith-Lemli-Opitz syndrome.

(DOUBLE TAKE) RUSSELL-SILVER SYNDROME (AKA SILVER RUSSELL SYNDROME)

Russell-Silver syndrome (AKA Silver Russell syndrome) is a type of dwarfism. Characteristics include growth retardation, clinodactyly, a small chin that gives a TRIANGULAR FACE, and hypospadias. Patients can also have hemihypertrophy of the head, trunk, arms, or legs.

IMAGE: www.pbrlinks.com/RUSSELLSILVER1
IMAGE: www.pbrlinks.com/RUSSELLSILVER2

MNEMONIC: Imagine a streetfighter or cage-fighter named RUSSELL. RUSSELL’s face is an asymmetric TRIANGLE (small chin with facial hemihypertrophy). His face is made out of SILVER, and this makes it easy for him to head-butt people during fights. Also, every time RUSSELL fights, he sprays yellow PEE all over the ground (because of hypospadias) and makes his opponents slip and fall. With tricks like that, of course he’s going to win every time!

UNDESCENDED TESTICLE

The risk of malignancy is increased for BOTH testicles even if only one testicle is undescended. The increased risk persists even after orchiopexy (surgical procedure done to move undescended testicle into the scrotum). The risk for infertility increases with increased time spent in the canal. If still undescended at 6 months of age, refer for orchiopexy to decrease chances of infertility.